Restoration of sensibility was evaluated by the "wrinkle test." Lateral Antebrachial Cutaneous Nerve Six patients complained of persistent anterior elbow pain. Results in dominant and nondominant extremities. Heterotopic ossification was the most common complication in the double-incision group, occurring in 36 of 498 cases (7.2%). The primary outcome was the . tag the tendon with heavy suture. Although . Lateral Antebrachial Cutaneous Nerve as In Situ Nerve ... Overall, the complication rate for distal biceps repair may approach 25%.11 Typical complications include neurapraxia, such as dysfunction of the posterior inter-osseous nerve and lateral antebrachial cutaneous nerve PDF Thomas E. Goodwin, MD Thomas M. Chopp, MD Joseph R. Lynch ... A case of mus-culocutaneous nerve injury after a biceps tenodesis has also been reported. In three patients, a direct transfer with a distal end-to-side repair through a deep longitudinal neurotomy was performed. Injury to the nerve results in loss of sensation along the radial aspect of the forearm. (9.7% vs 5.2%, P = .03). The findings of that systematic review are most consistent with the rate in the present study (11.7%). This case report describes an LABCN injury and forearm pain after a . The MABC nerve continues distally in the distal forearm and separates into two main branches (anterior branch and . superficial radial nerve injury. To our knowledge this is the first report of a brachial artery injury during a distal biceps tendon repair. Acute distal biceps tendon rupture increasingly common in active adults Operative fixation restores elbow function and strength Complications with operative repair: • Heterotopic bone formation • Posterior interosseous nerve and lateral antebrachial cutaneous nerve injury Relocation of neuromas of the lateral antebrachial cutaneous nerve of the forearm into the brachialis muscle. This nerve provides sensation to the lateral forearm. Cutaneous Blocks for the Upper Extremity - NYSORA Discussion. In acute cases the the retracted biceps tendon and the tendon tract were readily . Case Report A healthy, right-hand dominant 51-year-old man sustained injury to his right distal biceps while shoveling dirt. Surgical repair of Distal Biceps Injury preferred method of treatment in. Although . It was still adherent to the lacertus fibrosis. Often the distal end of the ruptured tendon can be palpated within the sheath. lateral antebrachial cutaneous nerve injury. Figure 5-1 The right infraclavicular brachial plexus has been exposed via an incision through the deltopectoral groove. The purpose of this Technical Note and video is to provide our preferred method of repair using an open, onlay . After dissection of the subcutaneous tissue, particular care must be given to the lateral antebrachial cutaneous nerve (LABCN), discerning it from the biceps brachii muscle to avoid secondary traction. Type of study/level of evidence . The lateral antebrachial cutaneous nerve continues distally to innervate the lateral aspect of the forearm. A single S-shaped incision was used. Two patients experienced transient paraesthesias in the lateral antebrachial cutaneous nerve region and one patient experienced stiffness of the elbow due to scarring of the wound, which resolved completely after vigorous physical therapy. lateral antebrachial cutaneous (LABC) nerve. Lateral antebrachial cutaneous nerve neurapraxia was the most common complication in the single-incision group, occurring in 77 of 785 cases (9.8%). lateral antebrachial cutaneous nerve (labcn) injury is the most common complication after distal biceps repair and occurs after approximately 6% to 13% of distal biceps repairs. Most common injury during two incision technique for repair of biceps tendon. Overall complications of distal biceps tendon repair are in the range of 16-18% with lateral antebrachial cutaneous nerve injury being the most common 2. Classically, entrapment of the lateral antebrachial cutaneous nerve has been documented at the lateral edge of the biceps tendon as it exits the deep fascia in the antecubital fossa. Course: The medial antebrachial cutaneous (MABC) nerve branches from the medial cord or the brachial plexus at a point just distal to where the medial brachial cutaneous nerve branches off.They course through the arm in close proximity to each other as well as the basilica vein. The nerve can become injured from aggressive retraction. We transferred the brachialis muscle branch of the musculocutaneous nerve (brachialis nerve) to the AIN using the vascularized lateral antebrachial cutaneous nerve (LACN) as a nerve graft to restore the flexion function of the fingers and thumb. 3. They found a mass of scar tissue around the retracted biceps tendon and next to the lateral antebrachial cutaneous nerve (nerve along the front and side of the elbow). the forearm is shared with the medial antebrachial cutaneous nerve and the lateral antebrachial cutaneous nerve that is the terminal branch of the musculocutaneous . 2-B) T1-weighted MRI sequences of the right upper arm show the ruptured and retracted coracobrachialis muscle, which occurred at the Distal biceps tendon ruptures are uncommon injuries that can cause impairment in range of motion and function. Identify the ruptured biceps tendon and sharply debride the macerated portions of the tendon. In a single patient, an interposition nerve graft was required. Restoration of sensibility was evaluated by the "wrinkle test." This nerve provides sensation only, it does not affect muscle strength. new technique of distal biceps tendon repair using an internal button - the Endobutton (Acufex). Early reports of biceps tendon repair through the anterolateral approach of Henry reported a high incidence of injury to the radial nerve, posterior interosseus nerve, and lateral antebrachial cutaneous nerve . These can lead to lateral forearm, elbow, and wrist symptoms that can mimic other disease processes. Limited anterior single incision technique had a higher rate of lateral antebrachial cutaneous nerve injury compared to extensile single incision. Chronic Distal Biceps Repair With an Achilles Allograft David Y. Ding, M.D., William E. Ryan, B.S., Eric J. Strauss, M.D., and Laith M. Jazrawi, M.D. Methods: Patients with an acute distal biceps rupture were randomized to either a single-incision repair with use of two suture anchors (n = 47) or a double-incision repair with use of transosseous drill holes (n = 44). Most nerve complications are . Early reports of biceps tendon repair through the anterolateral approach of Henry reported a high incidence of injury to the radial nerve, posterior interosseus nerve, and lateral antebrachial cutaneous nerve . The purpose of this study was It was then carefully dissected away. 2-A) and coronal (Fig. Abnormalities of the lateral antebrachial cutaneous nerve (LABCN) are associated with antecubital elbow conditions, such as distal biceps brachii tendon tears and traumatic cephalic vein phlebotomy. The brachial artery arises as an extension of the axillary artery after the distal aspect of teres major muscle and terminates at approximately one centimeter distal to the elbow joint giving rise to the radial and ulnar arteries [7]. 2. To our knowledge this is the first report of a brachial artery injury during a distal biceps tendon repair. The lateral antebrachial cutaneous nerve is identified and protected. Biceps Musculature; Incision. recurrent radial vessels encountered and either coagulated or carefully dissected and retracted protect PIN by limiting forceful lateral retraction and maintaining supination complications injury to the LABCN is most common 4. neuroma and nerve repair Permanent injury Re-exploration, resection of neuroma and nerve . 2-A) and coronal (Fig. The muscle-tendon junction must be identified, and the stump tendon caught. The risk of late deformity and poor . . The surgeons harvested a hamstrings graft from the patient, wove it in with the biceps stump, and used an EndoButton to hold the graft in . It should be carefully identified and protected during distal biceps repair, as a traction injury can result in numbness or paresthe-sias along the forearm. 2, 8, 9, 10 it is the most common complication following both single- and dual-incision repair techniques, but is more frequently reported with the single-incision … • One common complication after distal biceps tendon repair surgery is numbness and/or tingling on the thumb side of the forearm below the incision. A temporary palsy of the posterior interosseous nerve developed in one patient; it resolved in six months. The lateral antebrachial cutaneous nerve was identified in the subcutaneous plane, isolated, and protected throughout the surgery. The most frequent complication of a distal biceps repair is a lateral antebrachial cutaneous nerve paresthesia, mostly the consequence of aggressive retraction. 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